New study brings heartache to physicians trying to diagnose an acute coronary event

It would seem that the chest pain many patients fear to be a heart attack in the making does not accurately predict one s risk of having acute coronary syndrome or a heart attack (acute myocardial infarction, AMI), says a new study published in the Annals of Emergency Medicine.

It is common for lay people to cite high pain scores as a reason for patients to remain in the hospital for further testing, but our study demonstrates that is not necessarily evidence-based, said lead study author Anna Marie Chang, MD, of the University of Pennsylvania in Philadelphia, Penn. Our study, she added, provides further evidence that there is no typical presentation for acute coronary syndrome. (Acute coronary syndrome is also known as unstable angina, says ACSH's Dr. Gilbert Ross.)

Dr. Chang and colleagues analyzed the records of over 3,300 patients who went to the emergency room with symptoms of acute coronary syndrome (symptoms of coronary artery insufficiency, ranging from a heart attack to the chest pain of angina). After adjusting for sex, race, mode of arrival, and a specific compilation of risk factors used to identify patients at high risk for suffering a heart attack, they found that patients pain score alone could not predict whether a patient would experience a cardiovascular complication within 30 days.

Chest pain and related symptoms cause six million visits to the emergency department and approximately two million hospital admissions every year. Only a small minority are diagnosed with heart problems, while two to five percent of patients who come in with AMI are inappropriately discharged from the ER because their condition goes undiagnosed.

Dr. Ross advice to patients wondering whether or not they should go to the ER if they feel that worrisome chest pain? Err on the side of caution. It may not turn out to be a heart attack, but it s better to be safe than sorry.